Sheet 1: Organisation Summary

	
	
	
	
	
	
	
	
	

		

 
		
		
	

		
	

		


		


		


		


		


		


		


		


	
	

		


		
Name of IHS
		


		


	
	

		


		
Name of SP (if applicable)
		


		


	
	

		


		
IHSPS Budget 22/23
		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		
Remaining funds to be allocated
		
0.00 
		
Must be zero before IHS CEO/Service Provider can submit Work Plan
		
	

		


		


		


		


		


		


		


		


	
	

		


		


		
 Work Plan - Budget Allocation  (due 31 Jul 22) 
		
Progress Report #1
		
Progress Report # 2
		


		
Funds
		


	
	

		


		


		
Jul - Dec 2022                              (due 31 Jan 23)
		
Jan - Jun 2023                               (due 31 Jul 23)
		


		
Remaining
		


	
	

		
1
		
QUM Pharmacist Support
		
 $-   
		
 $-   
		
 $-   
		


		
0.00 
		


	
	

		
2
		
QUM Devices
		
 $-   
		
 $-   
		
 $-   
		


		
0.00 
		


	
	

		
3
		
QUM Education
		
 $-   
		
 $-   
		
 $-   
		


		
0.00 
		


	
	

		
4
		
Patient Transport
		
 $-   
		
 $-   
		
 $-   
		


		
0.00 
		


	
	

		


		
Allocation
		
 $-   
		
 $-   
		
 $-   
		


		
0.00 
		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		
PPA/Dept. of Health use only
		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		
Work Plan Approval
		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		
PPA
		
The Department of Health
		


		


		


	
	

		


		
Approved by
		


		


		


		


		


	
	

		


		


		
Date
		


		


		


		


		


	
	

		


		
Title/Role
		


		


		


		


		


	
	

		


		
Email
		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		
Progress Report #1
		
Progress Report #2
		


		


		


	
	

		


		


		
Progress Report Approval Date
		


		


		


		


		


	
	

		


		


		
Authorised Officer
		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	



Sheet 2: Work Plan

	
	
	
	
	
	
	

		


		
Please use YELLOW BOXES to complete your work plan.
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
1. QUM Pharmacist Support
		


		


		


		


		


		
Funds remaining to be allocated
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Service Provider/Pharmacist
		
Type of Support
		
Estimated No. of Hours/Days
		
 Cost per Hour/Day 
		
 Total 
		


		

 
		
		
	

		
1
		


		


		


		
 $-   
		
 $-   
		


		
	

		
2
		


		


		


		
 $-   
		
 $-   
		


		
	

		
3
		


		


		


		
 $-   
		
 $-   
		


		
	

		
4
		


		


		


		
 $-   
		
 $-   
		


		
	

		
5
		


		


		


		
 $-   
		
 $-   
		


		
	

		


		


		


		


		


		


		


		


		


		


		
	

		


		
Total funding allocated to - 1.QUM Pharmacist Support
		
 $-   
		


		


		


		
	

		


		
Comments (If you've chosen Option 5. 'Other' support, please provide further information below):
		


		


		


		


		


		


		


		


		
	

		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


		
	

		


		
PPA/DoH Use only for approved adjustments
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Comments
		
From
		
To
		
Total
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
2. QUM Devices
		


		


		


		


		


		
Funds remaining to be allocated
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
2.1 Approved items to be purchased
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Item
		
Quantity
		
 Estimated Cost per Item 
		
 Total 
		
Comments (if required)
		


		

 
		
		
	

		


		
Automatic BP monitors
		


		


		
 $-   
		


		


		
	

		


		
Glucometers
		


		


		
 $-   
		


		


		
	

		


		
Lancets (per box)
		


		


		
 $-   
		


		


		
	

		


		
Blood Ketone Test Strips
		


		


		
 $-   
		


		


		
	

		


		
Asthma Spacers
		


		


		
 $-   
		


		


		
	

		


		
Child Spacer Masks
		


		


		
 $-   
		


		


		
	

		


		
Adult Spacer Masks
		


		


		
 $-   
		


		


		
	

		


		
Nebulisers
		


		


		
 $-   
		


		


		
	

		


		
Nebuliser tubing bowl mask kits
		


		


		
 $-   
		


		


		
	

		


		
Peak Flow Metres
		


		


		
 $-   
		


		


		
	

		


		
Piko Digital Peak Flow Metre
		


		


		
 $-   
		


		


		
	

		


		
Tablet Cutters
		


		


		
 $-   
		


		


		
	

		


		
Tablet Crushers
		


		


		
 $-   
		


		


		
	

		


		
Ezy Drop eyedrop guide
		


		


		
 $-   
		


		


		
	

		


		
Pil-bob device
		


		


		
 $-   
		


		


		
	

		


		
Autosqueeze eye drop bottle squeezer
		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Dosette boxes
		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Pulse oximeters
		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
INR test strips
		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
 Approved items - subtotal 
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
2.2 'Other' items requiring Department of Health approval
		


		


		


		


		


		


		


		


		

 
		
		
	

		


		


		


		


		


		


		


		


		


		


		
	

		


		
 Item for approval 
		
Quantity
		
 Estimated Cost per item 
		
 Total 
		
 Dept Approval 
		


		
	

		
1
		


		


		


		
 $-   
		


		


		
	

		
2
		


		


		


		
 $-   
		


		


		
	

		
3
		


		


		


		
 $-   
		


		


		
	

		


		


		


		


		
 'Other' items - subtotal 
		
 $-   
		


		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


		
	

		
Please describe how the items requested meet the four approval criteria shown in the box to the right
		


		


		


		


		


		


		


		


		


		
	

		
1
		


		


		
	

		
2
		


		


		
	

		
3
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
PPA/DoH Use only for approved adjustments
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Comments
		
From
		
To
		
Total
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		
Total funding allocated to - 2. QUM Devices
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
3. QUM Education
		


		


		


		


		


		
Funds remaining to be allocated
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		

 
		
		


	
	

		


		
3.1. Clinical resources
		


		
Quantity
		
 Estimated Cost 
		
 Total 
		


		


		


		


		


	
	

		


		


		


		
Comments (if required)
		


		


	
	

		


		
Australian Medicines Handbook (AMH)
		


		


		
 $-   
		


		


		


	
	

		


		
eTherapeutic Guidelines (eTG)
		


		


		
 $-   
		


		


		


	
	

		


		
Monthly Index of Medical Specialities (MIMS)
		


		


		
 $-   
		


		


		


	
	

		


		
Medicines (Purple) Book for Aboriginal and Torres Strait Islander Health Practitioners
		


		


		
 $-   
		


		


		

 
		
		


	
	

		


		
Pregnancy & Breastfeeding Medicines Guide
		


		


		
 $-   
		


		


		


	
	

		


		
Australian Pharmaceutical Formulary
		


		


		
 $-   
		


		


		


	
	

		


		
Don't Rush to Crush
		


		


		
 $-   
		


		


		


	
	

		


		
Remote Primary Health Care Manuals
		


		


		
 $-   
		


		


		


	
	

		


		
Contraception: An Australian Clinical Practice Handbook
		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Australian Injectable Drugs Handbook
		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
UpToDate
		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Renal Drug Database
		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		
Approved items - Subtotal
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
3.2 'Other' resources requiring Department of Health approval
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Resource for approval
		
Quantity
		
 Estimated Cost 
		
 Total 
		
Dept Approval
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
1
		


		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
2
		


		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
3
		


		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		
'Other' items - Subtotal
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Reason for seeking approval 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
1
		


		


		

 
		
		
	

		
2
		


		


		
	

		
3
		


		


		
	

		


		


		


		


		


		


		


		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


		
	

		


		
3.3 Education and Training Sessions
		


		


		


		


		


		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


		
	

		


		
Activity
		
Proposed Date
		
Presented by (include profession)
		
Target Audience
		
 Proposed number of attendees 
		
 Cost 
		


		
	

		
1
		
<Describe activity>
		


		


		


		


		


		


		
	

		
2
		


		


		


		


		


		


		


		
	

		
3
		


		


		


		


		


		


		


		
	

		
4
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
5
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		
Sub Total for 3.3 Education and Training
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
PPA/DoH Use only for approved adjustments
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Comments
		
From
		
To
		
Total
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		
Total funding allocated to - 3. QUM Education
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
4. Patient Transport
		


		


		


		


		


		
Funds remaining to be allocated
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
Please provide an estimate of how many patients might access this service, if unsure leave blank: 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Option 4.1
		


		


		


		


		


		


		


		


		

 
		
		
	

		


		
Costing based on a set of cost per kilometre travelled.
		


		
	

		


		


		


		
	

		


		
Estimated No. of km / week
		
Cost / km
		
Total Cost
		
Comments
		


		


		


		


		
	

		


		


		
0.72
		
 $-   
		


		


		
	

		


		


		


		


		


		


		


		


		


		


		
	

		


		
Option 4.2
		


		


		


		


		


		


		


		


		
	

		


		
Costing based on allocating funds to cover the cost of a transport driver
		


		


		


		


		


		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


		
	

		


		
Estimated No. of driver hours per day
		
Estimated No. of days transport per year
		
Cost of driver wage per hour
		
Total Cost
		
Comments
		


		


		


		
	

		


		


		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Option 4.3
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Costing based on car running costs such as registration, insurance and maintenance.  
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Details
		


		
 Total Cost 
		
 Comments 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Registration
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Insurance
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Maintenance
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
Total Cost
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
PPA/DoH Use only for approved adjustments
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Comments
		
From
		
To
		
Total
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		
Total funding allocated to - 4. Transport
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Thank you for completing your IHSPS Work Plan. Please ensure the IHS CEO has reviewed and 'signed' this Work Plan Prior to Submission. Records supporting the activities undertaken in this Work Plan must be kept for 7 years for audit requirements as per the IHSPS Program Rules
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Comments:
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
PPA/DoH comments:
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
WORK PLAN SIGN OFF
		


		


		
Date
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Name of IHS CEO
		


		


		
Typing your name is considered a valid signature
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Submitted by
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Position Title
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Email
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	



Sheet 3: Progress Report #1

	
	
	
	
	
	
	
	
	

		
Progress Report #1 - (1 July 2022 - 30 December 2022)
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
1.  QUM Pharmacist Support
		


		


		


		


		


		


		


		


		


		
Funds allocated to QUM Pharmacist Suport
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Please report any expenses incurred in this category during the reporting period. Please only select '5. Other' under Type of Support if this has been pre-approved by the Dept. of Health and provide further detail in the Comments section 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Service completed by
		
Type of Support
		
No. of Hours/Days
		
Total Cost
		
Comments (if required)
		


	
	

		


		
<Insert Name of Pharmacist/SP>
		


		


		


		


		


	
	

		


		
<Insert Name of Pharmacist/SP>
		


		


		


		


		


	
	

		


		
<Insert Name of Pharmacist/SP>
		


		


		


		


		


	
	

		


		
<Insert Name of Pharmacist/SP>
		


		


		


		


		


	
	

		


		
<Insert Name of Pharmacist/SP>
		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		
Total expenditure - 1. QUM Pharmacist Support
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
2. QUM Devices
		


		


		


		


		


		


		


		


		


		
Funds allocated to QUM Devices
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Please report any expenses incurred in this category during the reporting period. Please only include 'Other' items that have been pre-approved by the Dept. of Health - please enter the details manually under section 2.2 'Other' Items purchased
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
2.1 Approved Items
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Item purchased
		
Qty
		
Unit Price
		
Total Price
		
Comments (if required)
		
Item purchased
		
Qty
		
Unit Price
		
Total Price
		
Comments (if required)
		


	
	

		


		
Automatic BP monitors
		


		
 $-   
		
 $-   
		


		
Ezy Drop eyedrop guides
		


		
 $-   
		
 $-   
		


		


	
	

		


		
Glucometers
		


		
 $-   
		
 $-   
		


		
Autosqueeze eye drop bottle squeezer
		


		
 $-   
		
 $-   
		


		


	
	

		


		
Lancets
		


		
 $-   
		
 $-   
		


		
Pil-bob devices
		


		
 $-   
		
 $-   
		


		


	
	

		


		
Blood Ketone Test Strips
		


		
 $-   
		
 $-   
		


		
Dosette boxes
		


		
 $-   
		
 $-   
		


		


	
	

		


		
Asthma Spacers
		


		
 $-   
		
 $-   
		


		
Pulse Oximeters
		


		
 $-   
		
 $-   
		


		


	
	

		


		
Child Spacer Masks
		


		
 $-   
		
 $-   
		


		
INR test strips
		


		
 $-   
		
 $-   
		


		


	
	

		


		
Adult Spacer Masks
		


		
 $-   
		
 $-   
		


		
2.2 'Other' Items purchased 
		
Qty
		
Unit Price
		
Total Price
		
Comments (if required)
		


	
	

		


		
Nebulisers
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Nebuliser tubing bowl mask kits
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Peak Flow Meters
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Piko Digital Peak Flow Metres
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Tablet Cutters
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Tablet Crushers
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		
Total expenditure - 2. QUM Devices
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
3. QUM Education
		


		


		


		


		


		


		


		


		


		
Funds allocated to QUM Education
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Please report any expenses incurred in this category during the reporting period. Please only include 'Other' resources that have been pre-approved by the Dept. of Health - please enter the details manually under section 3.2 ' Other' resources purchased
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
3.1 Clinical resources
		


		


		


		


		


		


		


		


		


		


		


		


		
3.2 'Other' resources purchased 
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Resources purchased
		
Qty
		
Unit Price
		
Total Cost
		
Comments ( if required)
		
'Other' resources purchased 
		
Qty
		
Unit Price
		
Total Cost
		
Comments (if required)
		


	
	

		


		
Australian Medicines Handbook (AMH)
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
eTherapeutic Guidelines (eTG)
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Monthly Index of Medical Specialities (MIMS)
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Medicines (Purple) Book for Aboriginal and Torres Strait Islander Health Practitioners
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Pregnancy & Breastfeeding Medicines Guide
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Australian Pharmaceutical Formulary
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Don't Rush to Crush
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Remote Primary Health Care Manuals
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Contraception: An Australian Clinical Practice Handbook
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Australian Injectable Drugs Handbook
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
UpToDate
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		
Renal Drug Database
		


		
 $-   
		
 $-   
		


		


		


		
 $-   
		
 $-   
		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Please report any expenses incurred during the delivery of Education and Training activities to your staff or clients below
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
3.3 Education and Training
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Delivered by
		
Activity
		
Date
		
No. of attendees
		
Total Cost
		
Comments (if required)
		


	
	

		


		
<Insert Name of Educator and Role>
		


		


		


		
 $-   
		


		


	
	

		


		
<Insert Name of Educator and Role>
		


		


		


		
 $-   
		


		


	
	

		


		
<Insert Name of Educator and Role>
		


		


		


		
 $-   
		


		


	
	

		


		
<Insert Name of Educator and Role>
		


		


		


		
 $-   
		


		


	
	

		


		
<Insert Name of Educator and Role>
		


		


		


		
 $-   
		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		
Total expenditure - 3. QUM Education
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
4. Patient Transport
		


		


		


		


		


		


		


		


		


		
Funds allocated to Patient Transport
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Please report any expenses incurred in this category during the reporting period. 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		
If applicable, please indicate how many patients have used this service:
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		
Comments (if required)
		


		


		


		


		


		


		


	
	

		


		
Option 4.1 - Distance travelled
		
No. of km travelled this period
		
Cost/km 
		
Total Cost
		


		


		


		


		


		


		


		


	
	

		


		


		
 $0.72 
		
 $-   
		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


	
	

		


		
Option 4.2 - Driver's salary
		
$ p/hour
		
hours p/day
		
Days worked p/PR1
		
Total Cost
		


		


		


		


		


		


		


		


	
	

		


		
 $-   
		


		


		
 $-   
		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


	
	

		


		
Option 4.3 - Transport vehicle expenses
		
Registration 
		
Insurance
		
Maintenance
		
Total Cost
		


		


		


		


		


		


		


		


	
	

		


		
 $-   
		
 $-   
		
 $-   
		
 $-   
		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		
Total expenditure - 4. Patient Transport
		
 $-   
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Progress Report Completion
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Please complete the signing block to acknowledge that the information provided is true, correct and complete.
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
If you would like to leave any comments, please do so in the box provided to the right
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		
Comments:
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Name of CEO or SP
		


		
Typing your name is considered a valid signature
		


		


		


		


	
	

		


		
Submitted by
		


		


		


		


		


		


		


	
	

		


		
Role/Title
		


		


		


		


		


		


		


	
	

		


		
Email
		


		


		


		


		


		


		


	
	

		


		
Submission date
		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Approved by
		


		
For PPA use only
		


		


		


		


	
	

		


		
Approved date
		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		

 
		
		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
PPA/DoH Comments: